1915(i) Care Manager Birth Month Alignment Frequently Asked Questions (FAQs) and Resources

• If the 1915(i) assessment was submitted by the health plan and not directly to Carelon, please contact the health plan for the status of the 1915(i) assessment. 
• Inquiries to Carelon regarding 1915(i) assessments, including status updates and follow-up questions in response to requests for additional information, may be directed to the following email address: Questions.NCMC1915i@carelon.com.
  • Please note that Carelon will only respond to the email address that originally submitted the assessment.
• Please note that the determination process may take longer than 14 calendar days if outreach is needed to obtain additional information.
• If Carelon sends a request for additional information, please respond directly to the original email thread that contains the subject line, "1915(i) Waiver Outreach – Information Requested."
  • Please do not initiate a new email when responding.
• The email address for 1915(i) assessment and reassessment submissions remains the same: NCMedicaid1915irequests@carelon.com.

Birth month planning will begin with members who have October birthdays, and the full rollout will be completed by Nov. 1, 2027.

1915(i) eligibility ends on the last day of the birth month; the next birth cycle begins the first day of the following month. The Care Plan/Individualized Service Plan (ISP) is effective the first day of the following month, regardless of the actual day of birth.

The gap Care Plan/ISP is never more than one year; the gap period is shorter, not longer than 12 months. The initial Care Plan/ISP (gap Care Plan/ISP) extends from the 1915(i) service’s effective date through the final day of the member’s birth month.

No. The initial Care Plan/ISP (gap Care Plan/ISP) will span from the 1915(i) service’s effective date to the final day of the member’s birth month. The next Care Plan/ISP will run for a full twelve month period, beginning on the first day of the month after the member’s birth month and ending on the last day of the member’s birth month the following year. There will be only one gap Care Plan/ISP.

No. To align with the birth month planning cycle, a 1915(i) assessment is required at multiple points: an initial 1915(i) assessment for the first period, a separate 1915(i) assessment for the short gap period and an annual 1915(i) assessment thereafter to determine 1915(i) eligibility.

Yes. To align with the birth month planning cycle, a 1915(i) assessment is required at multiple points: an initial assessment for the first 1915(i) period, a separate assessment for the short gap period and an annual assessment thereafter to reestablish 1915(i) eligibility.

Example:  Member has a plan that expires Nov. 15, 2026. Member has a January birthday. Your next Care Plan/ISP will be a gap plan that will start Nov. 16, 2026, and run through Jan. 31, 2027.

The short-term Care Plan/ISP (gap plan) used for transitioning to the birth month cycle. The initial Care Plan/ISP (gap Care Plan/ISP) will span from the 1915(i) service’s effective date to the final day of the member’s birth month. A plan cannot exceed twelve months.

The initial Care Plan/ISP and eligibility will be an abbreviated or gap Care Plan/ISP. The gap Care Plan/ISP and 1915(i) eligibility will end on the last day of the member’s birth month. The next Care Plan/ISP will begin on the first day of the month following the member’s birth month and will end on the last day of their birth month.

No. Do not delay access to services to align with the birth month cycle. It is important to move forward with the process to begin 1915(i) services as early as possible. Care managers must submit the 1915(i) assessment and develop the member’s Care Plan/ISP so services can start.

Yes. A gap Care Plan/ISP should be created, ending on the last day of the member’s birth month. Care managers should submit the 1915(i) assessments requesting eligibility that aligns with the gap Care Plan/ISP. The subsequent Care Plan/ISP will start on the first day of the month after the birth month and will conclude on the final day of the member’s birth month.

Here are relevant resources: 

• 1915(i) Birth Month Calculator Tool - August 2026
• 1915(i) Birth Month Calculator Instruction Video - August 2026
• 1915(i) Birth Month Training Presentation Slides - August 2026
• 1915(i) Birth Month Training Video - August 2026

When released, the updated 1915(i) assessment tool will be posted the TCM website here: Information for Tailored Care Management Providers | NC Medicaid (See 1915(i) Material for link to tool)

The revised 1915(i) Assessment Tool (Version 3.0) must be used for all assessments effective Oct. 1, 2026.  TCMs should refer to guidance from the beneficiary’s assigned health plan for the health plan’s implementation timeline requirements for transitioning to Version 3.0 of the 1915(i) Assessment Tool.

• NC 1915(i) Assessment Version 3.0 - Effective- Oct. 1, 2026
• NC 1915(i) Assessment Tool Companion Guide

No. Only the Care Manager signs the 1915(i) assessment.  The care manager may sign the assessment using a digital signature, a typed script style font, or a traditional wet signature. The member/guardian/legally responsible person is not required to sign the 1915(i) assessment. 

If the 1915(i) assessment was submitted by the health plan and not directly to Carelon, please contact the health plan for status of the 1915(i) assessment.

Inquiries to Carelon regarding 1915i assessments including, status updates and follow up questions in response to requests for additional information may be directed to the following email address: Questions.NCMC1915i@carelon.com. Please note that Carelon will only respond to the email address that originally submitted the assessment.

Please note that the determination process may take longer than 14 calendar days if outreach is needed to obtain additional information.  If Carelon sends a request for additional information, please respond directly to the original email thread that contains the subject line "1915i Waiver Outreach – Information Requested".

Please do not initiate a new email when responding.  Care managers should plan ahead when submitting 1915(i) annual reassessments for eligibility. Annual 1915(i) reassessments should be submitted (to Carelon or health plan) 60 days prior to the member’s 1915(i) eligibility end date.

The email address for 1915i assessments and reassessments submissions remains the same: NCMedicaid1915irequests@carelon.com.

No, 1915(i) eligibility cannot exceed 12 months. 

Care managers should plan ahead when submitting 1915(i) annual reassessments for eligibility. Annual 1915(i) reassessments should be submitted (to Carelon or the health plan) 60 days prior to the 1915(i) eligibility end date. This will provide time for Carelon to complete eligibility determination and for all dates to remain aligned.

The updated 1915(i) assessment tool will enable care managers to request the 1915(i) eligibility start date on gap and annual assessments only. Ongoing monitoring for eligibility decisions is important.

Carelon is transitioning to birth month alignment. They will only approve eligibility for a full twelve-month period.

Any reassessments submitted and approved to transition to the birth month cycle will supersede the previous Carelon eligibility dates.

Carelon completes 1915(i) assessment eligibility reviews within 14 calendar days. If information is missing or clarification is needed, the review period may extend beyond 14 days.

Care managers should plan ahead when submitting 1915(i) annual reassessments for eligibility. Annual 1915(i) reassessments should be submitted (to Carelon or the health plan, per your health plans direction) 60 days prior to the member’s 1915(i) eligibility end date.
 

Carelon sends copies of all 1915(i) decision letters to the health plans.

TCM providers may request copies of the letters from the health plans. Carelon mails copies of the 1915(i) decision letters to the members/guardian/legally responsible person. 

The CMCA is conducted annually as part of the Care Plan/ISP development process and is separate from the 1915(i) assessment. The 1915(i) reassessment must be completed each year during annual planning for members who wish to continue receiving 1915(i) services.

No. CMCAs should be completed annually as part of developing the member’s Care Plan/ISP. If a new CMCA is needed for the annual Care Plan/ISP, complete it without waiting for the birth month cycle. If the CMCA is part of a gap Care Plan/ISP, a new CMCA is not required  unless the situation also meets the criteria for a reassessment.

A new CMCA may be triggered by one of the triggering events listed in the TCM Provider Manual: Section 4.3: Care Management Comprehensive Assessment – Requirements for Reassessment. The Care Plan/ISP may not exceed 12 months and must include a wet or electronic signature from the member, guardian, or legally responsible person.

In other circumstances in which a CMCA may have been recently performed, the CMCA reassessment may consist of an addendum or update to a previous assessment, rather than conducting a full reassessment, and should capture specific updates relevant to the triggering event.

Yes. Some Health Plans refer to the CMCA as the term Health Risk Assessments (HRAs) to refer to Care Management Comprehensive Assessments (CMCA). For all Plans CMCA/HRAs will also shift to birth month alignment so all annual paperwork is completed at the same time, on the same cycle. Thus, CMCA/HRAs, 1915(i) assessments, and Care Plan/ISPs will all come into alignment with the birth month.

Yes. The Care Plan/ISP must be signed by the member/guardian/legally responsible person whenever there is an edit to the plan.

Yes. Care managers must develop a new annual Care Plan/ISP for each member. The Care Plan/ISP may not exceed 12 months. Care Plans/ISPs cannot be extended during birth month alignment. The Care Plan/ISP must be signed (wet or electronic signature) by the member/guardian/legally responsible person.

Following the same methodology used for Innovations Waiver planning, the Care Plan/ISP for 1915(i) services will be effective on the first day of the calendar month after the individual’s birth month and may not exceed 12 months. Signature dates will not determine the Care Plan/ISP effective or end date for members receiving 1915(i) services.

No. A Care Plan/ISP must be completed and signed (wet or electronic signature) by the member/guardian/legally responsible person. The Service Authorization Request (SAR) or Treatment Authorization Request (TAR) must cover the entire duration of the Care Plan/ISP in order for the 1915(i) service provider to receive reimbursement for services rendered.

Please note that LTCS is an In Lieu Of Service, not a 1915(i) service. However, LTCS services may be included in the member’s Care Plan/ISP to ensure visibility of all services and prevent duplication. For more information, visit Program Specific Clinical Coverage Policies | NC Medicaid

Yes, within 14 days of completion.

Care managers develop a Care Plan for each member with behavioral health needs and/or an ISP for each member with intellectual/developmental disabilities (I/DD) and traumatic brain injury (TBI) needs.

Care managers working with members with co-occurring I/DD/TBI and behavioral health diagnoses should develop either a Care Plan or ISP based on input from the member and/or their legally responsible person/guardian.

After a member is determined eligible for 1915(i) services, there are additional components involved in the process.

• All 1915(i) services must be included in the member’s ISP/Care Plan signed by the member/guardian/legally responsible person.
• If the health plan requires a SAR /TAR, there must be approvals prior to the start of 1915(i) services (inclusive of add-ons).
• The SAR/TAR must cover the entire duration of the Care Plan/ISP in order for the 1915(i) service provider to receive reimbursement for services rendered.

There is a maximum of 1200 units per plan year. The health plan UM team will make all authorization determinations.

Prior authorization depends on the health plan. Please follow the Health Plan’s guidance on prior authorization.

Health plans are not required in contract to follow the 1915(i) Clinical Coverage Policy (CCP). DHB removed prior authorization from most of the behavioral health CCPs in January 2025, but most of the health plans have received approval from the NC Medicaid parity team to add prior authorizations and limits to their policies.

To ensure 1915(i) service providers will be paid for service delivery it is best practice for care managers/care to check with the member’s assigned health plan to know if they need prior authorization for a service. If the health plan requires a SAR /TAR, it must be approved prior to the start of 1915(i) services. The SAR/TAR must cover the entire duration of the Care Plan/ISP for the 1915(i) service provider to receive reimbursement for services rendered.

No. 1915(i) eligibility is effective for 12 months. If the health plan requires a SAR /TAR, it must be approved prior to the start of 1915(i) services. The SAR/TAR must cover the entire duration of the Care Plan/ISP in order for the 1915(i) service provider to receive reimbursement for services rendered.

The health plan’s UM teams are aware of the birth month plan updates.

Coordinate with TCM agency leadership. Your agency leadership may want to consider using structured tools such as spreadsheets with automated reminders or care management software with alert features.

These tools can help ensure timely monitoring of due dates and annual requirements. Some agencies align all annual planning tasks within the same month.

A wet signature is a signature made by hand using ink. For example, signing your name with a pen on a paper document.

Work with your TCM agency leadership. The annual Care Plan/ISP serves as the service authorization and may not exceed 12 months.

As such, there must be a new Care Plan/ISP each year.